After kick-starting AZ's police opioid plan, Kingman rescuers 'doing the best that we can'

Plagued by overdoses, this city innovated a solution. But similar bottom-up answers might be harder to come by in the future.

Sgt. Brian Zach, with the Kingman Police Department in northwest Arizona patrols the streets Nov. 17, 2017. While figures show pain pill prescriptions in Arizona dropped nearly 10 percent over the last decade — 70.2 opioid prescriptions per 100 people — they have continued to rise in Mohave County and rural communities, like Kingman.(Photo: Jason Pohl/The Arizona Republic)

Story Highlights

The Kingman Police Department was the first in the state to create a Narcan training program.

Their program became the model across Arizona.

Some are wondering how else rural resource-scarce communities can find solutions of their own.

A 29-year-old man was unresponsive at an RV park a stone's throw from Interstate 40 in this historic northwest Arizona city nestled along Route 66.

Rubbing knuckles on the man's sternum — a painful tactic first responders use to awaken people — didn't have an effect. Neither did repositioning and shaking him. For a few minutes that felt like hours, a Kingman police officer was alone to render aid.

Trained in the use of naloxone just one month prior, the officer administered two doses of the opioid overdose-reversing drug, causing the man to snap awake.

He survived.

“It was exciting,” said Rusty Cooper, deputy chief of the 54-sworn Kingman Police Department. "That got some buy-in from the officers.”

Kingman was the first Arizona agency to train its officers to use naloxone, sold under the brand name Narcan, even as some in the industry balked at the idea.

In the six months that followed, Kingman police administered naloxone three more times, each on patients believed to have been overdosing on heroin.

“This doesn’t solve the overriding issue. We’re very aware of that," Cooper said. "This is a Band-Aid, a stopgap.”

The bottom-up innovation implemented by Kingman police would later become the state standard used to train and equip law enforcement in reversing opioid overdoses.

To understand why Kingman took on that role, one has to go back nearly a decade to when the opioid epidemic rooted here.

The Kingman Police Department was the first in Arizona to implement a training program for its officers to carry opioid overdose-reversing naloxone. Agencies across the state have since implemented the training.(Photo: Jason Pohl/The Republic)

More prescriptions than people

The high-desert community of Kingman is the hub of Mohave County, a city of 30,000 people bolstered by jobs at the nearby hospital, county government and positions in the manufacturing sector.

It's also a major pass-through city tucked 100 miles from Las Vegas and at the junction of four major highways, including Interstate 40.

There was plenty of traffic when Dr. Albert Szu Sun Yeh began operating what amounted to a drive-through pill pick-up for OxyContin, Percocet and Vicodin on the outskirts of Kingman.

That so-called "pill mill," for which the doctor was convicted in 2009, put opioid distribution in rural Arizona on the map.

“It’s just exploded since then," Cooper said.

While figures show pain-pill prescriptions in Arizona dropped nearly 10 percent over the last decade — 70.2 opioid prescriptions per 100 people — they have continued to rise in Mohave County and other rural areas.

“The per-capita death rate in rural America is far worse than anything you’re seeing in urban America. That’s showing up, I think, a little bit more so in Arizona as well. That is just catastrophic.”

James Hodge, a law professor at Arizona State University specializing in public health, ethics and emergency preparedness

Heroin deaths have more than tripled since 2012 in Arizona, a much faster growth rate than overdose deaths from prescription such as oxycodone and Vicodin, officials have said. A total of 790 Arizonans died from verified opioid overdoses in 2016, and heroin accounted for 39 percent of those deaths.

Though confirmed figures from 2017 are not yet available, data from enhanced tracking efforts suggest at least 716 people in Arizona are believed to have died of opioid-related overdoses during a six-month stretch of 2017, far exceeding previous death statistics that span an entire calendar year.

First responders statewide have administered more than 3,600 doses of overdose-reversing naloxone since enhanced tracking began. Reliable data about overdose fatalities before and after expanded naloxone use began is not yet available.

James Hodge is a law professor at Arizona State University specializing in public health, ethics and emergency preparedness. When discussing opioid overdoses, he recommended looking beyond death tolls and instead focusing on how widespread addiction issues affect smaller communities — issues that won't disappear only by restricting access to prescriptions.

"The per-capita death rate in rural America is far worse than anything you’re seeing in urban America," he said. "That’s showing up, I think, a little bit more so in Arizona as well. That is just catastrophic.”

Azcentral

From inspiration to action

Faced with a rising tide of drug-induced emergencies, Cooper and his public-safety counterparts began looking for answers.

One training session at a convention of the International Association of Chiefs of Police in 2015 piqued the interest of Kingman Police Chief Robert DeVries. The topic: police use of naloxone, long hailed by EMS as an opioid overdose-reversing drug.

No lesson plan or written protocol existed in Arizona for police officers to train and carry the substance. Inspired to test a program locally, the chief asked Cooper to make it happen.

Spearheading the program ensured a seat at the policy table.

“A lot of things or expectations are based on what they’re doing in the State of Maricopa,” Cooper said, referring to the rural-urban divide with equal parts bitterness and sarcasm in his voice. "That doesn’t always fit for what we’re doing in a more rural area.”

Dan Winder, a battalion chief with Kingman Fire Department, partnered with Cooper on the naloxone training and rollout. Heather Miller, a trauma program manager and pre-hospital coordinator at Kingman Regional Medical Center, also pitched in.

Kingman police officers began learning how to use dual nose-spray Narcan kits in August 2016, and they were the first in Arizona to do so.

Officers with the Kingman Police Department check out Narcan kits at the start of each patrol shift. The department was the first in Arizona to train and equip officers with the opioid overdose-reversing substance.(Photo: Jason Pohl/The Arizona Republic)

The program had buy-in from throughout the department, Cooper said, though some expressed concern that providing the life-saving drug could potentially enable the continuation of destructive, overdose behavior.

“Just because someone makes a bad choice doesn’t mean their life is not worth saving," Cooper said. "If we’re there five minutes early (before EMTs), a few minutes early, that’s what we do. There is no argument against that.”

The Arizona Peace Officer Standards and Training Board began discussing and working on a naloxone training plan in 2016, but it wasn't until Kingman got involved that it turned into something concrete.

Authorities statewide have implemented similar programs since mandates came down from the governor's officeinJune.

Dozens of public-safety agencies — from police departments in Peoria and Flagstaff, to tribal authorities, even state livestock officers — have received thousands of free naloxone kits from the Arizona Department of Health Services.

There were more than 60 overdoses without a fatality in the Kingman area in that time.

'Best that we can'

But bringing back someone from the brink doesn't mean they're able to begin dealing with their addiction.

Patient follow-ups are lacking, especially in many rural areas, according to the state's comprehensive opioid action plan. Some places don't have access to resources or experts who focus on crisis response or general behavioral health.

“At the end of the day, we have to rely on each other," Miller said. "We don’t have anybody else. All we have is each other."

While legislation signed in January allocated $10 million for treatment, that's likely a drop in the bucket considering the thousands of people who overdosed last year in cities big and small. A statewide telemedicine program, where patients with substance-use disorders can dial in for treatment and consultations, could be part of the solution.

Until then, first responders in Kingman and other parts of the state feel like their options are limited.

“I guess in our little neck of the woods in northwestern Arizona," Winder said, "we’re just doing the best that we can."